Toward a reconstruction of medical morality

At the center of medical morality is the healing relationship. It is defined by three phenomena: the fact of illness, the act of profession, and the act of medicine. The first puts the patient in a vulnerable and dependent position; it results in an unequal relationship. The second implies a promise to help. The third involves those actions that will lead to a medically competent healing decision. But it must also be good for the patient in the fullest possible sense. The physician cannot fully heal without giving the patient an understanding of alternatives such that he or she can freely arrive—together with the physician—at a decision in keeping with his or her personal morality and values. In today's pluralistic society, universal agreement on moral issues between physicians and patients is no longer possible. Nevertheless, a reconstruction of professional ethics based on a new appreciation of what makes for a true healing relationship between patient and physician is both possible and necessary.     

Toward a reconstruction of medical morality

At the center of medical morality is the healing relationship. It is defined by three phenomena: the fact of illness, the act of profession, and the act of medicine. The first puts the patient in a vulnerable and dependent position; it results in an unequal relationship. The second implies a promise to help. The third involves those actions that will lead to a medically competent healing decision. But it must also be good for the patient in the fullest possible sense. The physician cannot fully heal without giving the patient an understanding of alternatives such that he or she can freely arrive--together with the physician--at a decision in keeping with his or her personal morality and values. In today's pluralistic society, universal agreement on moral issues between physicians and patients is no longer possible. Nevertheless, a reconstruction of professional ethics based on a new appreciation of what makes for a true healing relationship between patient and physician is both possible and necessary.     

Adolescent Decisional Autonomy Regarding Participation in an Emergency Department Youth Violence Interview

Much attention has been given to determining whether an adolescent patient has the capacity to consent to research. This study explores the factors that influence adolescents' decisions to participate in a research study about youth violence and to determine positive or negative feelings elicited by being a research subject. The majority of subjects perceived their decision to participate to be free of coercion, and few felt badly about having participated. However, adolescents who were alone in the room during the assent process were more likely to report that they chose freely to be a research subject. This study may influence the ways physicians communicate with adolescent patients around research assent within a clinical care environment.     

Is it acceptable for a physician to break confidentiality in the case of sexually transmitted diseases? A mapping of young Kuwaiti's views

IntroductionConfidentiality is essential for the establishment of trust between physicians and their patients.ObjectivesThe circumstances under which it is acceptable to young Kuwaiti for a physician to break confidentiality to protect the spouse of a patient with a sexually transmitted disease (STD) were examined.MethodA sample of 263 young Kuwaiti indicated the acceptability of breaking confidentiality in 48 scenarios that were all possible combinations of five factors: disease severity, time taken by the physician to discuss with the patient, the patient's intent to inform the spouse about the disease, the patient's intent to adopt protective behaviors, and the decision to seek the advice of an expert in infectious diseases before breaking confidentiality.ResultsThrough cluster analysis, four qualitatively different positions were found: Quite never acceptable (6% of the sample, mostly males), Depends on husband's willingness to inform (3%), Depends on husband's protective behavior (29%, mostly females), and Quite always acceptable (32%). The remaining participants did not express any clear view.ConclusionIn Kuwait, students’ trust in the medical profession is, therefore, not likely to be seriously undermined if, from time to time, and in well-specified cases, individual physicians decide to break confidentiality when facing dilemmas of the kind examined in the current study.     

Empathy and humanitarianism predict preferential moral responsiveness to in-groups and out-groups

ABSTRACT

The current research tests whether empathy—sharing others’ emotions—and humanitarianism—recognizing the moral worth of all people—each predict moral responsiveness toward others but in ways that favor in-groups and out-groups, respectively. In Studies 1 and 2, empathy and humanitarianism differentially predicted preferential moral concern for in-groups and out-groups. In Study 3, humanitarianism predicted lower in-group-targeted prosociality and greater out-group prosociality. In Study 4, empathy and humanitarianism predicted perceived moral obligation to in-groups and out-groups respectively. In Study 5, out-group obligation mediated between humanitarianism and allocations to out-group charities, and in-group obligation mediated between empathy and one of two in-group charities. In sum, empathy and humanitarianism are associated with preferential morality via group-based obligation, suggesting that morality could be extended by altering empathy, humanitarianism, or group processes.     

Informed Consent Revisited: Japan and the U.S.

Informed consent, decision-making styles and the role of patient–physician relationships are imperative aspects of clinical medicine worldwide. We present the case of a 74-year-old woman afflicted with advanced liver cancer whose attending physician, per request of the family, did not inform her of her true diagnosis. In our analysis, we explore the differences in informed-consent styles between patients who hold an “independent” and “interdependent” construal of the self and then highlight the possible implications maintained by this position in the context of international clinical ethics. Finally, we discuss the need to reassess informed-consent styles suitable to the needs of each patient regardless of whether he or she resides in the United States or in Japan.     

Parenting practices and adolescent social anxiety: A direct or indirect relationship?

Background/ObjectivesAccording to existing evidence, parental educational practices and social anxiety are to some degree connected. However, the possibility that this relationship is an indirect one and is mediated by individual factors such as self-esteem or emotional regulation has not yet been explored. The aim of this study was therefore to explore the relationship between maternal and paternal educational practices and social anxiety, and test both the direct and the indirect pathways. Method: The representative sample consisted of 2,060 Andalusian students (47.7% girls, M_age = 14.34) who filled in various self-reports. Results: The structural equation models confirmed that a direct relationship, with a low effect size, exists between parental educational practices and social anxiety and that there is also an indirect relationship, mediated by negative self-esteem and emotional suppression (the emotional regulation strategy), which accounted here for 49.1% of the variance in social anxiety. Conclusions: Parental education practices seem to act as a family asset which either promotes or hinders the development of basic attitudes and competencies such as self-esteem or emotional regulation and, by doing this, either encourages or prevents the emergence of problems such as social anxiety.     

<Emphasis Type="Italic">Recta Ratio Agibilium</Emphasis> in a medical context: the role of virtue in the physician-patient relationship

Acting for the good of the patient is the most fundamental and universally acknowledged principle of medical ethics. However, given the complexity of modern medicine as well as the moral fragmentation of contemporary society, determining the good is far from simple. In his philosophy of medicine, Edmund Pellegrino develops a conception of the good that is derived from the internal morality of medicine via the physician-patient relationship. It is through this healing relationship that rights, duties, and privileges are defined for both physicians and patients. Moreover, this relationship determines the characteristics or virtues that are necessary to engage in the medical telos. This paper addresses the role of the moral virtues in clinical medicine and the physician-patient relationship. First, it provides a brief background of the Aristotelian foundations of virtue-ethics. Second, it delves into Pellegrino’s philosophy of medicine understood as a practice oriented towards a teleological goal. Third, it relates the telos of medicine to the notion of the medical community as a fundamentally moral community. Finally, it concludes with a section that creates a dialogue between virtue ethics and principlism.     

Self‐Realization and Owing to Others: An Indirect Constraint?

Abstract

The relationship between self‐realization, and so what I really wholeheartedly endorse and owe to myself, and morality or what we owe to others is normally thought of as antagonism, or as a pleasant coincidence: only if I am indebted to such relations as my fundamental projects that I care wholeheartedly about does morality have a direct connection to self‐realization. The aim of this article is to argue against this picture. It will be argued that the structure of self‐realization and the caring activity involved commits the person to values that are beyond the object of his wholehearted caring, in a way that might just pave the way to morality.     

The Context and Argument of The Political Philosophy of Needs

Abstract

In this translation of Charles Taylor’s paper, ‘Die Immanente Gegenaufklarung: Christentum und Moral’, the author discusses the relationship between Christianity and morality, in the light of developments in the West over the past five centuries. Particular attention is paid to the relationship between morality and the development of unbelief, the rejection of God, and atheism.     

Trust and the Healing Encounter: An Examination of an Unorthodox Healing Performance

Just why a patient should trust a particular healer isa question that has not been adequately explored inthe literature on healing. This ethnographiccase-report examines the healing performance of achiropractor and proposes that it contains fourintrinsic claims to trustworthiness: he claims to bea qualified and sincere healer who is inpossession of knowledge and techniques that derivetheir power from their truth content and whichempower him to make beneficial changes in thepatient. Taking each claim in turn I described thenature of the claim, how it might be adequatelyvalidated, ways in which his healing performance mightvalidate it and how he might be assisted by thepatient, and how their actual validation may bedistorted by the healer and patient. It is suggestedthat while unusual in many regards, this unorthodoxhealing performance may be a foil by which toexamine other more orthodox healing performances.     

Understanding the Effects of Cognition in Creative Decision Making: A Creativity Model for Enhancing the Design Studio Process

ABSTRACT

The essential components of creativity—persons, processes and products—were investigated inside a creative environment by deeply focusing on the cognitive stages of the creative decision making process. Mental imagery and external representation were considered as the implicit parts of creativity for enhancing design studio process. An experiment was conducted with 15 subjects who designed the public area of a train as the task in design studio. Observation, protocol analysis, and rating scales were used as assessment tools. Considering the components of creativity, it was found that the highest correlation was between process and overall creativity. Person and product followed process, respectively. However, no significant relationship was observed between imagery and creativity in design process. Three-dimensional representations were found to lead to more creativity compared to 2-dimensional depictions.     

Role of HIV serostatus,relationship status of the patient,homophobia, and social desirability of the psychologist on decisions regarding confidentiality

Abstract

What factors influence a psychologist's decision to maintain or break confidentiality of an HIV-positive patient? Dangerousness (serostatus), identifiability (relationship status of patient and third party), homophobia, and impression management were the major factors examined. The sample was composed of 236 psychologists and psychologists in training attending the 1994 American Psychological Association (APA) convention in Los Angeles, California. They were given 16 scenarios depicting four different situations with patients at various HIV risk levels, and measures determining levels of impression management and homophobia. A majority (51% to 92.2%, depending on the scenario) of the respondents chose to maintain confidentiality in all scenarios. Participants were least likely to maintain confidentiality in scenarios describing a high level of dangerousness and identifiability.     

Transgression and altruism: A case for hedonism

A model to account for the positive relationship between transgression and altruism was proposed and tested against three alternative formulations—Guilt, Social Justice, and Self-esteem Bolstering. The proposed model, Negative State Relief, asserts that people in a transgression situation behave charitably in order to reduce a general, negative affective state which is induced by exposure to harm-doing and that if the negative state is relieved by some other means, benevolent activity will be rendered unnecessary. All of the experimental subjects were exposed to an act of transgression; half performed the act themselves while half only witnessed it. In one set of experimental conditions (the relief conditions), a positive event—the receipt of either money or approval—was interposed between the harmful act and a fellow-student's request for aid. In another set of experimental conditions (the norelief conditions), no such positive event occurred. It was found, as predicted, that subjects who received a positive event were significantly less helpful than those who did not, but were not different from a control group which had never been exposed to the transgression. It was also found that harm-doers and harm-witnesses were identical in benevolent tendency. The results were interpreted as favoring a hedonistic conception of the nature of altruism. Finally, it was contended that a U-shaped relationship exists between mood state and helping tendency.     

Standing in Between: The Healing Praxis of Mayan Women Intermediaries in Post-Genocide Guatemala

ABSTRACT

This article examines how Mayan intermediaries make meaning of their roles in accompanying Mayan women survivors of gross violations of human rights as they search for truth, justice, and reparation in post-genocide Guatemala. Using a constructivist grounded theory approach, the authors analyzed in-depth interviews with six intermediaries who worked with survivors in the context of a seven year feminist participatory and action research project. The findings reveal that healing from the legacies of armed conflict as well as from historical racialized gendered oppression are at the core of Mayan intermediaries’ work with the Mayan women survivors with whom they established an intersubjective relationship, contributing to each other’s healing. The importance of economic justice for survivors’ healing and the scant and circumscribed talk about sexual violence—the grievance central to the work with most of the survivors—emerge as important findings of this study and require future exploration.     

THE MORALITY,POLITICS, AND IRONY OF WAR: Recovering Reinhold Niebuhr's Ethical Realism

The American experience of war is ironic. That is, there is often an intimate and unexamined relationship between seemingly contrary elements in war such as morality and politics. This article argues that without understanding such irony, we are unlikely to reflect in morally comprehensive ways on past, present, or future wars. Traditional schools of thought, however, such as moralism and political realism, reinforce these apparent contradictions. I propose, then, an alternative—“ethical realism” as informed by Reinhold Niebuhr—that better explains the irony of war. Through an ethical realist examination of the U.S. Civil War, World War II, and the Iraq War, I consider how American political interests have been inextricably linked with deep moral concerns. Ethical realism charts a middle path that ennobles traditional realpolitik while eschewing certain perfectionist tendencies of moralism. Ethical realism provides a conceptual framework for evaluating these other frameworks—a distinct form of moral‐political deliberation about war.     

What Is Conventionalism about Moral Rights and Duties?

A powerful objection against moral conventionalism says that it gives the wrong reasons for individual rights and duties. The reason why I must not break my promise to you, for example, should lie in the damage to you—rather than to the practice of promising or to all other participants in that practice. Common targets of this objection include the theories of Hobbes, Gauthier, Hooker, Binmore, and Rawls. I argue that (1) the conventionalism of these theories is superficial; (2) genuinely conventionalist theories are not vulnerable to the objection; and (3) genuine moral conventionalism is independently plausible.     

Psychoanalyst's Values and Countertransference

On the subject of countertransference we attempt to establish a line of continuity between Freud's own expression "blind spot" and Fromm's idea of "counterattitude". It is pointed out that both expressed the idea of the analyst's unconscious as an "instrument" for understanding the patient's unconscious. It follows that the decision to openly use or not to use countertransference in analysis also depends on the concept we have of it and on its extent. The psychoanalyst's real and illusory values and his convictions with regard to human nature influence the countertransference and the analytic relationship. Analytic listening itself may be distorted by it. We must be highly aware of this to avoid enclosing what the patient says in a theoretic scheme. What is needed, therefore, is an open theoretic scheme, more oriented towards understanding than interpretation. Aspects of analytic communication and of the relationship between language, thought and insight are examined. A humanistic point of view is assumed in distinguishing between the transferral and the real plane, and the reasons behind the legitimacy of such a distinction are expounded.     

Philosophy as Therapy: Towards a Conceptual Model

Abstract

The idea of philosophy as a kind of therapy, though by no means standard, has been present in metaphilosophical reflection since antiquity. Diverse versions of it were also discussed and applied by more recent authors such as Wittgenstein, Hadot and Foucault. In order to develop an explicit, general and systematic model of therapeutic philosophy a relatively broad and well-structured account provided by Martha Nussbaum is subjected to analysis. The results obtained, subsequently, form a basis for a new model constructed around the set of notions intrinsically connected with any, philosophical, psychological, or medical, form of therapy. The conceptual framework of: disease and its symptoms, the health ideal, the process of treatment with its techniques, therapeutic theory, physician, patient, and the physician-patient relationship is constructed and investigated in the context of its possible metaphilosophical use. An illustrative application of this scheme to philosophical therapy developed by Stoicism is, then, discussed. Finally, the issue of the therapeutic metaphilosophy's scope as well as the problem of therapeutic philosophy's specificity and integrity are briefly indicated.